<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label for="c-bank_name" class="control-label col-xs-12 col-sm-2">{:__('Bank_name')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-bank_name" data-rule="required" class="form-control" name="row[bank_name]" type="text" value="{$row.bank_name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label for="c-bank_card_no" class="control-label col-xs-12 col-sm-2">{:__('Bank_card_no')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-bank_card_no" data-rule="required" class="form-control" name="row[bank_card_no]" type="text" value="{$row.bank_card_no|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label for="c-bank_card_holder" class="control-label col-xs-12 col-sm-2">{:__('Bank_card_holder')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-bank_card_holder" data-rule="required" class="form-control" name="row[bank_card_holder]" type="text" value="{$row.bank_card_holder|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
